Autumn Lake Healthcare at Summit Park

In the surveyor’s words

From the most serious findings on record at Autumn Lake Healthcare at Summit Park, in the surveyor’s own words.

• Actual harm, isolatedF698Dec 22, 2023

  Based on record review and staff interviews, it was determined that the facility failed to: 1) accurately monitor residents for weight loss and to communicate dialysis residents' accurate condition (body weight loss reported as weight gain) with the dialysis center, which resulted in harm for Resident #78 due to an 8-day hospitalization for low blood volume; 2) report the resident's weight to the dialysis center and physician before Resident #76's blood pressure dropped, and 3) ensure an effective communication system between the dialysis center; 4) report and/or document the dialysis residents' conditions with physicians. This was evident in 2 (Resident #76 and #78) of 2 dialysis residents' records reviewed during the survey. […]

• No harm, potential for more than minimal, widespreadF925Aug 27, 2025

  Based on record review, resident interview, and staff interview, it was determined that the facility failed to maintain an effective pest control program. This was evident in 4 out of 4 units and had the potential to affect all residents. The findings include:On 8/26/2025 at 9:18 AM, a review of Complaint #330032 was completed. The complainant alleged that Resident #52's room had a common problem with mice.On 8/26/2025 at 9:43 AM, an observation and resident interview was conducted of Resident #52 and their room. No observation made of mice, but mouse droppings observed by another surveyor during the initial pool process along with gnat and fly sightings made by all surveyors through out all units and the facility. Resident #52 stated that the last mouse sighting was about 2 weeks prior. […]

• No harm, potential for more than minimal, widespreadF584Dec 22, 2023

  Based on surveyor observation and staff interview it was determined the facility staff failed to keep the building clean, neat, attractive and in good repair. This was evident in the four nursing units on both floors of the facility. The findings include: On 12/13/23 observations were made in the resident shared room B-14 and the findings were corroborated with the unit manager (staff #24) at 11:10 AM. Both wheeled IV feeding poles (utilized for enteral liquid feeding) bases appeared to have splashes of built up dried enteral liquid feeding. The unit manager suspected that both IV feeding pole bases were dirty with dried enteral liquid feeding, and she attempted to remove the substance with a paper towel. […]

• No harm, potential for more than minimal, widespreadF801Dec 22, 2023

  Based on interviews of facility staff, it was determined that the facility failed to ensure a full-time clinically qualified nutrition professional for the oversight of food preparation and the daily kitchen operation. All the residents in the facility have the potential to be affected by not having a qualified nutritional professional with the appropriate competencies and skill sets to carry out food and nutrition services. The findings include: An interview was conducted with the Food Service director (staff #4) 12/03/23 at 9:25 AM. She indicated that she has overseen the kitchen for the past 3 months. She was asked if she was a certified dietary manager (CDM) and she replied that she was not. […]

• No harm, potential for more than minimal, widespreadF812Dec 22, 2023

  Based on observation, interview, and documentation review it was determined that the person in charge of the kitchen failed to 1) ensure kitchen staff utilized effective hair restraints, 2) ensure the required sanitation levels of the facility's dishwashing machine, 3) keep vents and pipes and conduits clean and in good repair, and 4) ensure sanitary conditions for storage/transfers of ice to reduce the risk of foodborne illness. This practice had the potential to affect all residents that consumed food that was prepared by the kitchen. The findings include: 1. Initial inspection of the kitchen was initiated on 12/3/23 at 8:26 AM. […]